With assisted death, Christian clergy face profound questions
Many ministers and chaplains have wrestled with MAID and their own beliefs
Peter McQuaid was scheduled to die the following Monday, but first he wanted to see a priest.
His wife, Connie, was apprehensive. The Catholic Church had staked its opposition to medical assistance in dying, the course Peter planned to take. As she put it, "MAID is not for everybody." Still, she reached out to a priest she knew.
He agreed to come to the McQuaid home in the town of Souris, P.E.I. He heard Peter's confession in the living room and anointed him with oil, a Catholic ritual known as the sacrament of the sick.
"He felt as part of being a priest, he was to be supportive of the person in their journey, in their life, not necessarily agreeing or disagreeing with what their decision was," Connie said in an interview.
"And I thought, 'Oh, this is just what we need to hear.' We just felt like he was supporting people. Peter wasn't asking his permission, but he just wanted that peace with the church."
Peter McQuaid, facing the prospect of a dreadful decline from Alzheimer's disease, chose an assisted death in February 2020. But the priest who agreed to visit a few days prior and give the sacraments also made a choice, whatever his misgivings, and those of his church, with MAID.
Peter's funeral, officiated by another priest, was held in the local Catholic church, an imposing gothic revival sandstone building on the north side of town. He is buried in the graveyard across the street.
Nearly 45,000 Canadians died through MAID between 2016, the year it became legal in Canada, and 2022. It has been widely discussed and debated, and continues to be controversial, especially as eligibility has expanded.
But an often overlooked aspect has been the profound effect it has had on some Christian clergy and chaplains. Many who had not previously given the idea deep thought were now confronted with patients and parishioners choosing MAID.
Some have embraced it. Others have rejected it on theological grounds, such as sanctity of life principles. Still others view spiritual care as a duty, no matter the decisions of the patient. Many wrestle with it.
David Maginley, a former chaplain in the Halifax hospital system who has sat at the deathbeds of hundreds of people, vividly remembers attending his first MAID in 2017.
The patient's body was withered by end-of-life cancer, but he had "shining eyes." The disease would kill him soon, likely within a week, but he didn't want to wait.
As the two talked, the man spoke of a childhood memory of lying in the grass, staring at the sky and eating a Jos Louis cake. Maginley popped out and bought him one.
Just hours later, with his wife holding him, the patient was injected with the drugs that would take his life. Maginley recalls him saying: "I love you and goodbye, thank you."
It was, it seemed, a "beautiful" death. But Maginley said he was struck by something unexpected.
"I'm at the foot of the bed and seeing that big, that gigantic white vial of medication go into him," he said. "It just felt so different than removal of life-support or natural death. It was so different. We were causing death."
Unsure what to do next, Maginley prayed the man would be at peace, that he could once again lie down in the grass in the sunshine, that he would watch over his family.
Maginley returned to his office, locked the door and "fell apart." What had he just witnessed? Had he colluded in death? Wasn't this compassionate?
Since then, he's been at the bedsides for about 10 more MAIDs. Some have been "horrible," most have been "what we would call kind." But his distress remained. MAID, he worries, is about clinging to control in a medical model that aims to fix things.
"Most people, as they die, move into a mystical or a transpersonal state of consciousness," he said.
"They're filled with peace, equanimity, they have mystical visions — these are universal. And it really changes not only their fear of death, but the family's process of grief. It's beautiful. But I don't see it happening with MAID. We shut you off before you reach that stage."
He realized he could no longer attend assisted deaths. Unwilling to simply step back from those cases, leaving them to other chaplains, he took early retirement in January after 25 years in spiritual care, and has written a book about what he has learned that he expects to publish soon.
With assisted death, deeply held values rub up against each other, according to April Hart, a United Church minister in Bible Hill, N.S., who interviewed clergy and chaplains about MAID for her master of divinity research.
There's a belief that taking a life is wrong, but what about the suffering some people are forced to endure? Does offering MAID mean less attention is paid to better palliative care? In a culture that will take extreme medical measures to prolong life, is there a place to intervene to take life?
She began to think in earnest about how clergy were grappling with MAID during a chaplaincy internship at the Halifax Infirmary hospital. It coincided with a deeper examination of her own beliefs.
She was struck, she said, by how the six clergy and chaplains she interviewed all viewed it as an honour and a privilege to be asked to journey with a patient or parishioner who had decided on MAID.
She herself has attended six MAIDS. It is, she said, an "incredibly intimate experience." She's developed a short liturgy, a service with prayer and song, so assisted death isn't simply a "medical procedure." Health staff often join, she said.
But MAID can also be fraught, accompanied at times by overwhelming secrecy or bitterly divided family members.
One minister Hart interviewed found herself at the home of a parishioner on the day she was to die and came face to face with the chair of her church council, an attending nurse. Neither knew the other was involved in the assisted death until then, and they never spoke about it.
Another interviewee said she was asked by a person who received MAID to call three of her adult children, meet with them and read them a card telling them that she had died and how. They were angry.
What's also come to preoccupy some clergy are the motivations of patients seeking MAID. They worry there are cases where it's not the horrible pain that's driving the decision, but the feeling of worthlessness, that they will burden their families, that it's pointless to go on with life.
Some worry that kind of "existential distress" is not often examined with enough depth over many hours, and that MAID then becomes, as one interviewee told Hart, a "medical procedure to treat a spiritual condition."
In Canada, people eligible for a medically assisted death must be at least 18 and mentally competent, have a "grievous and irremediable medical condition," voluntarily ask for MAID and give informed consent, and must go through two independent medical assessments.
Hart herself initially wondered if she would ever come to a place where she was comfortable with MAID. Her first experience changed a lot in her mind — a man whose quality of life was gone but who had a "deep peace." But not every minister will get there, she acknowledged, and that's OK.
"I hope that there will always be people who will question MAID, and I hope that I will always have questions about it because, you know, every time the legislation changes and there are wider parameters, I take a long time thinking about it," she said.
"I don't know how I feel about every change that comes. I think that this is really important, something that's very important that's happening in our society. I would never want us to get to a point where everyone of us is sort of so on board that we're complacent about it."
Gloria Woodland, a former hospital and palliative care chaplain in British Columbia, recalls a patient in her 70s who had been single all her life and was struggling with chronic health problems.
MAID was not yet legal, but the woman would beg staff who came into her room to help her end her life, and plead for Woodland to convince them. Between the pain, and nobody needing her, she saw no reason to continue living.
"At that point in time, I just fell back on the law and could say, 'No, it's not legal,'" Woodland said. "I didn't have to go any further than that. I would have pastoral conversation with her, but it would stop there because it couldn't go any further than that."
That all changed in 2016. Woodland was by then director of the chaplaincy and spiritual care program at ACTS Seminaries, which is part of Trinity Western, a Christian university in Langley, B.C. Clergy and former students began calling.
Some were struggling with what was right, she said. They were holding theological positions that seemed opposed to MAID, but also the "pastoral heart that wanted to journey with someone through this."
"Others were simply calling me saying, 'Gloria, this came up and I've never faced it before. I don't know what to do,'" Woodland said.
It's what led her to devise an eight-week online course that delves into MAID, with the aim of taking students through the assisted-death process, then exploring their own beliefs and position on it, including deciding whether they can be at the bedside for it.
"What I always say is that's between them and God," she said. "I'm not going to tell them how far they can go."
Woodland said she believes in the "dignity of life," that humans are made in the image of God, and she broadly shares a pro-life position. Many of her students are the same.
But she also believes it's her duty to share the love and compassion of God, and she likely would be willing to be at someone's side during an assisted death.
"As much as my desire for an individual would be that they don't have MAID, I'm not the judge. It's their choice," she said. "I just want to make sure that they know that God loves them, even when they make that choice."
Maginley, the former longtime Halifax hospital chaplain, has a striking memory of another patient who sought an assisted death. She had lived on the streets and had been abused, and MAID was her way out of a terrible life.
But in palliative care, Maginley said, she was offered such compassion that she changed her mind.
"The compassion was offering something she never expected, hadn't experienced," he said. "The remedy is compassion."
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